Under a Group Employee Medical Plan benefits are provided to each employee/dependent in many different forms. Health Maintenance Organizations (HMO’s) provide coverage for doctors and hospitals that are in their networks only. Point of Service (POS’s) provides coverage both in network and out of network at different usual, customary and reasonable (UCR) levels. Preferred Provider Organizations (PPO’s) provide coverage both in network and out of network with no referrals needed in network.
Health Savings Accounts (HSA’s), Health Reimbursement Arrangements (HRA’s), and Flexible Spending Accounts (FSA’s) are methods used to reduce medical premiums and have the employee share in the management of their health care. They may be administered by a third party administrator (TPA).
A key to a successful plan is making sure the employee’s annual out of pocket expense is kept at a reasonable level and that most of the doctors and hospitals currently used by employees are in the network chosen.